Nursing Elites

1. The nurse is assisting with the admission of a young adult female Korean exchange student with acute abdominal pain. Although the client has been able to easily answer questions, when asked about sexual activity, she looks away. What action should the nurse take?

• A. Omit the section of the assessment form
• B. Ask her if she would like an interpreter to help her understand the question
• C. Reword the question to make it more culturally sensitive
• D. Observe the client's response when asked a different question

Correct answer: D

Rationale: Observing the client's response to another question is the most appropriate action in this scenario. By doing so, the nurse can assess whether the client's discomfort is due to cultural sensitivity or a misunderstanding. This approach allows the nurse to proceed with sensitivity and respect, ensuring effective communication. Option A is incorrect because omitting the section of the assessment form may result in missing crucial information relevant to the client's condition. Option B jumps to assumptions about a language barrier without confirming it first. Option C focuses on rewording the question without addressing the underlying issue causing the client's discomfort, which may not necessarily be due to a lack of understanding.

2. Which of the following is NOT a second-line agent used for the treatment of Tuberculosis?

• A. Amikacin
• B. Moxifloxacin
• C. Rifabutin
• D. Cycloserine

Correct answer: C

Rationale: The correct answer is C, Rifabutin. Rifabutin is actually a first-line drug used in the treatment of tuberculosis. Choices A, B, and D (Amikacin, Moxifloxacin, and Cycloserine) are considered second-line agents for tuberculosis treatment. These drugs are used when the first-line medications are either ineffective or cannot be tolerated by the patient.

3. The nurse is preparing to provide wound care for a client. Which step should be done first?

• A. Don procedural gloves
• B. Remove the dressing
• C. Apply prescribed medications to the wound
• D. Don a pair of sterile gloves

Correct answer: A

Rationale: The correct answer is to don procedural gloves first. Donning procedural gloves is essential to protect the nurse from contaminants while removing the old dressing. This step helps maintain aseptic technique and prevents the transfer of microorganisms. Removing the dressing (choice B) should follow after wearing gloves to prevent the spread of pathogens. Applying prescribed medications (choice C) should be done after the wound is cleaned and dressed. Donning a pair of sterile gloves (choice D) is not necessary for initial wound care; procedural gloves are sufficient for standard wound care.

4. A nurse is assessing a day-old infant for jaundice. Which of the following is the best method for this?

• A. Applying pressure over a bony area such as the forehead and evaluating the skin color after the pressure is removed
• B. Assessing the color of the infant’s hands and feet
• C. Assessing the infant’s tongue
• D. Assessing the infant’s arms and legs

Correct answer: A

Rationale: The correct answer is A. Applying pressure over a bony area and evaluating the skin color after the pressure is removed is the most accurate method for assessing jaundice in a day-old infant. This technique helps in identifying any yellowing of the skin, which is a key indicator of jaundice. Choices B, C, and D are less effective methods for assessing jaundice in a newborn. Assessing the color of the hands and feet may not give a reliable indication of jaundice, while evaluating the tongue, arms, and legs are not as specific or accurate as applying pressure over a bony area.

5. Which condition is characterized by a progressive loss of muscle strength due to an autoimmune attack on acetylcholine receptors?

• A. Myasthenia gravis
• B. Multiple sclerosis
• C. Amyotrophic lateral sclerosis
• D. Guillain-Barré syndrome

Correct answer: A

Rationale: The correct answer is A: Myasthenia gravis. Myasthenia gravis is characterized by muscle weakness caused by autoimmune attack on acetylcholine receptors at the neuromuscular junction. This results in impaired communication between nerves and muscles. Choice B, Multiple sclerosis, is a condition where the immune system attacks the protective myelin sheath covering the nerves in the central nervous system, leading to communication issues between the brain and the rest of the body. Choice C, Amyotrophic lateral sclerosis, is a progressive neurodegenerative disease affecting motor neurons in the brain and spinal cord, not involving acetylcholine receptors. Choice D, Guillain-Barré syndrome, is an acute condition where the immune system attacks the peripheral nerves, causing muscle weakness and paralysis, but it does not target acetylcholine receptors.

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